Objectives: Premature infants, particularly those requiring neonatal intensive care unit (NICU) stays, are at high risk for developmental delay. Non-English primary language (NEPL) families may have more difficulty navigating the healthcare system, and less knowledge of available developmental resources. While the literature suggests older children in NEPL families have poorer clinical outcomes compared to English-speaking families, there remain limited data assessing developmental outcomes among high-risk infants in NEPL families. Our objective was to use a nationally representative survey to determine if preterm infants of Hispanic Spanish speaking families had increased risk of developmental delays when compared to Hispanic and non-Hispanic English speaking families. Study Design: In this cross-sectional study using data from the 2016-2018 National Survey of Children’s Health (NSCH), we compared developmental outcomes for preterm infants (defined as <37 weeks gestation) who live in families that identify as Hispanic Spanish-speaking, Hispanic English-speaking, or Non-Hispanic English-speaking. Our primary outcome was caregiver reported prevalence of combined developmental delay, defined as: difficulty using hands or with coordination (if child < 5 years), difficulty walking/climbing stairs or dressing (6-17 years), speech delay, and/or general developmental delay. Subsequent analyses will assess differences in outcomes between the groups after accounting for confounders including infant characteristics (e.g., birth weight, sex, medical complexity), social determinants of health (e.g., maternal education, marital status, medical home) and recency of immigration to the US. All analyses used survey weights to provide nationally representative estimates. Results: A total of 8.27 million children were identified as being born preterm in our sample, among whom 1.95 million met our definition as having general developmental delay. Hispanic Spanish speakers were more likely to be uninsured (p<0.001), more likely to have public insurance (p<0.001), and less likely to be born in the US (p<0.001; see Table 1). Hispanic Spanish speakers were also more likely to live in metropolitan areas (p<0.001) and were less likely to have a comprehensive medical home for their child compared to Non-Hispanic English speakers (26.57% vs. 52.76%, p<0.001). Hispanic Spanish speakers were more likely than Non-Hispanic English caregivers to report their child having difficulty with coordination (29.6% vs 12.6%, p=0.04) and difficulty using hands (28.40% vs 10.5%, p=0.02; see Table 2). There were no statistically significant differences between Spanish speaking families and English speaking families in regards to speech delays, general developmental delays, or combined developmental delay. Conclusions: These data suggest that Spanish speaking families with preterm infants may be at higher risk for experiencing certain early developmental delays and inequities in their ability to access to healthcare. Language, rather than ethnicity, may be a more important risk factor in a child having these developmental delays, and needs to be investigated further.
Parental Primary Language and Developmental Delays in Preterm Neonates
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Lindsay A. Sternad, Stephen W. Patrick, Melissa McPheeters, Carolyn Heinrich, Elizabeth McNeer, Theresa Scott; Parental Primary Language and Developmental Delays in Preterm Neonates. Pediatrics March 2021; 147 (3_MeetingAbstract): 717–719. 10.1542/peds.147.3MA7.717b
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